Screening for Spiritual Struggle
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Transcript of Screening for Spiritual Struggle
Screening for Spiritual StruggleScreening for Spiritual Struggle
Judith Blanchard, D.Min., B.C.C. – Chaplain Clinical Leader
A Quality Improvement Initiative at Maine Medical Center, Portland ME
Winter-Spring 2011
Judith Blanchard, D.Min., B.C.C. Chaplain Clinical Leader
Douglas Allan Dunlap, Ed.M., Ed.D, M.Div., Chaplain Resident
Objectives
NURSING COLLABORATION
– Learn how one might engage nursing staff in screening for
religious/spiritual struggle.
QUALITY IMPROVEMENT
– Gain familiarity with a quality improvement project for in-patient spiritual care.
N=230 patients with advanced cancer.From Balboni et al, J of Clinical Oncology, 2007
Importance of Religion to Cancer Patients
Very important
68%
Somewhat important
20%Not
important12%
Religious/spiritual struggle
may compromise recovery may increase risk of mortality compromises emotional adjustment
to illness and quality of life
Fitchett, 2012
“I am told that God lives in me – and yet the reality of darkness and coldness and emptiness is so great that nothing touches my soul.” Newsweek 9/3/07
SPIRITUAL DISTRESS
Addressing Spiritual Struggle/Distress means:
“…to help create an environment where what is fundamental, natural, and indigenous to the human psyche can most easily do its own work of
bringing about integration, balance, and wholeness.”
Michael Kearney (2000)
Nursing recruitment from:
• Nursing Director recommendation• Chaplain Invitation• Peer Referral• Personal Interest – Self Referral
Current Nursing Questions:
Interdisciplinary Screens:Any spiritual practices thatmay affect your care? No Yes________________________
Chaplain X2951
Was there a time when you did?
Yes No
Is that helping you now?
Yes No
Thank you. We do wish to be supportive of you.[Make SCM Pastoral Care Consult Order or call 662-2951 with referral. Note which Track patient on.]
#1BELIEFHelpful
Spiritual Screening Tool
Yes No
#2BELIEF
Not Helpful
#3BELIEF
in Past
#4No
BELIEF
Patient Admitted: Our team is committed to the whole person.Do you have a belief, spiritual or otherwise, that is important to
you?
10 Nurses Recruited and Trained 1 – Injured and unavailable 3 – No referrals (1 nurse said she had
made a couple but no record) 2 – made one referral 3 – made two referrals 1 – made six referrals 14 Referrals made in six weeks
Results of 14 Nursing Referrals
#1 Belief Helpful N = 7
#2 Belief Not Helpful N = 3
#3 Belief in Past N = 1
#4 No Belief N = 3
Conclusions:• Nurses are interested in their patients’
spiritual well-being• Nurses will volunteer to contribute to a
project addressing SS/SD• Nurses observe spiritual distress in their
patients• Protocol enabled more RN e-referrals
Participating nurses reported
• the screening protocol provided terminology and a procedure that they found helpful in discussing the spiritual domain with their patients.
Screening for Spiritual Struggle and Aims for Quality Improvement
AimAim Screening ProtocolScreening Protocol
Aim #2: Care is Effective Aim #2: Care is Effective (evidence-based)(evidence-based)
A) The protocol is based on research A) The protocol is based on research indicating the harmful effects of spiritual indicating the harmful effects of spiritual struggle. B) Other studies show the struggle. B) Other studies show the effectiveness of the protocol.effectiveness of the protocol.
Aim #3: Care is Patient-Aim #3: Care is Patient-CenteredCentered
Use of the protocol increases the likelihood Use of the protocol increases the likelihood that patient's preferences for spiritual care that patient's preferences for spiritual care services are respected.services are respected.
Aim #4: Care is TimelyAim #4: Care is Timely
The protocol reduces the time between The protocol reduces the time between admission and referral for spiritual care or admission and referral for spiritual care or assessment.assessment.
Aim #5: Care is EfficientAim #5: Care is Efficient
The protocol makes efficient use of non-The protocol makes efficient use of non-chaplain healthcare staff to reduce the time chaplain healthcare staff to reduce the time chaplains spend in patient identification.chaplains spend in patient identification.
Aims for quality improvement from the Institute of Medicine 2001 report, Aims for quality improvement from the Institute of Medicine 2001 report, Crossing the Crossing the Quality ChasmQuality Chasm. . The protocol does not explicitly address Aim #1: Care is Safe, or Aim #6: Care is Equitable.The protocol does not explicitly address Aim #1: Care is Safe, or Aim #6: Care is Equitable.A summary of the report is available at A summary of the report is available at http://iom.edu/CMS/8089/5432/27184.aspx. . Fitchett, 2012Fitchett, 2012
Follow up by chaplains
Findings and plans for the future
We are all in this together!We are all in this together!
Questions and Answers